Cervicovaginal cytology in carcinosarcoma [malignant mixed mullerian (mesodermal) tumor] of the uterus

Abstract

We examined the cervicovaginal cytology (PAP) findings in a series of 21 endometrial and 2 cervical carcinosarcomas (CS) [malignant mixed mullerian (mesodermal) tumors] (MMMT). Initial cytology diagnosis was positive for cancer in 14 of 23 cases (sensitivity of 61%); however, CS was correctly identified only 2 times. The remaining 12 cancer diagnoses were carcinomas: 10 adenocarcinomas (4 endometrial, 1 cervical, and 5 adenocarcinomas not otherwise specified), 1 squamous carcinoma, and 1 poorly differentiated carcinoma. Seventeen smears were available for review, all 8 false negative, one unsatisfactory, and 8 of 14 true positive smears. One false negative smear showed rare clusters diagnostic of adenocarcinoma. The remaining 7 false negative smears showed 3 high grade squamous dysplasias (two with additional findings: one showed atypical spindle cells and the other showed endometrial stromal cells), 2 extensive repair changes, and 2 negatives. The unsatisfactory smear showed atypical spindle cells. Review of the 8 true positive smears confirmed malignant spindle cells in the two cases originally identified as CS by cytology and in 3 other cases originally identified as adenocarcinoma. Of 9 smears positive for cancer available for review, 4 showed only carcinoma cells. PAP positive for cancer was associated with high stage at presentation (P less than .025) and recurrent disease (P less than .001) (even among stage I or II patients, P less than .025). PAP positive for cancer showed no association with depth of myometrial invasion, size, grade, or histologic type of carcinosarcoma. The results of this study demonstrate the importance of consultative cytology reporting in which recommendations for appropriate biopsy are included in the report.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant Mixed Müllerian Tumor with an Extensive Squamous-Cell Carcinomatous Component: A Potential Pitfall in Liquid-Based Cervical Cytology

“…Our case confirmed that the sarcomatous component does not shed easily, even in a case of predominant sarcoma on histology [18]. The presence of a sarcomatous component in a cervical Pap smear has also been identified as a characteristic feature [4,11]. …”

“…Cytological reports with atypical or positive results have shown that sensitivity in cases of histologically proven MMMT ranges from 44 to 70% [4,18]. In the study by Snyder et al [18],after cytology revision, the sensitivity increased from 44 to 60%, with 15/25 Pap tests showing features atypical or positive for carcinoma.…”

“…In cases of MMMT of the cervix, Pap smears are rarely reported to be abnormal, and the initial manifestation is primarily vaginal bleeding or spotting [19]. Costa et al [4 ]correctly diagnosed MMMT of the uterus in 2/23 cases and found that tumor diathesis was a characteristic feature in 5 (63%) of the 8 malignant Pap smears, in agreement with findings in other studies [20]. Our case confirmed that the sarcomatous component does not shed easily, even in a case of predominant sarcoma on histology [18].…”

“…In the past, reports of the cytological findings of MMMTs considered these tumors to be sarcomas [4]. More recently, preoperative cytological diagnoses have been described using cervicovaginal smears, peritoneal effusion cytology and endometrial and peritoneal fine-needle aspiration [4,5,6,7,8,9].…”

“…More recently, preoperative cytological diagnoses have been described using cervicovaginal smears, peritoneal effusion cytology and endometrial and peritoneal fine-needle aspiration [4,5,6,7,8,9]. With the diffusion of liquid-based cytology (LBC) in screening programs for uterine cervix carcinoma, the possibility of encountering such tumors has increased [10].…”